SNF charge nurses or DON - a few questions

I am interested in getting some input from nurses who have SNF experience, and in particular those who may have served as Director of Nursing or ADON.

How challenging/stressful is the setting? Do nurses there generally feel overworked and underpaid? If you were a DON, how much time was spent filling in on the floor and how much was spent doing administrative work? If you were a DON, did you carry a pager or were you expected to be on call 24/7? Of course it all depends on geographic area and the facility itself, but I’m curious approx. how much is the salary? How stressful is a facility survey? (been through those in dialysis and home health, so I think I already know the answer). What strengths do you think are most important to work in the SNF setting?

Any stories, good-bad-or ugly, particularly from a DON, would be helpful to me. I have no SNF experience except as a student, however I am an RN with over 20 years of teaching and hands on nursing experience.

I don’t know how much help this will be because I’m in Australia but I’ll give you some of my thoughts.

I currently work as a 2CO in a largeish aged care facility. My duties are flexible because I was taken on super-numerary mainly to facilitate an IT system which hasn’t yet been introduced. Currently, I’m filling in for a documentation nurse who left (yes, we have full-time documentors) but generally speaking, my job is a mix of clinical issues, CI, QA (meeting the hefty legislative requirements) and staff management.

It’s very challenging and stressful. In this country we find that we are constantly squeezed by the demands of the government funding body and the government accreditation body. Add in the severe nursing and care worker shortage and the rising expectations of residents and relatives…well, it’s a pressure cooker. Wages here for aged care nurses are generally about 10 - 20% under that paid in public or acute sectors and care workers receive less than they would if they worked on a factory production line.

The majority of places I have worked, the DON’s role was very much “hands-off”. She spent most of her time with administrative tasks. DONs here are always on-call 24/7. I suppose australian salaries are irrelevant to you but here it ranges from 70 - 110k depending on size of facility/organisation. For all I know, there are probably DONs out there being paid more - with the industry in crisis, we currently name our price.


I’ve an idea that the US system is similar to ours in that failure to meet standards can result in a loss of funding or ultimately closure of the facility. I’ve heard professors of nursing referring to aged care in Australia being the most regulated in the world. Unfortunately, ours is a flawed system - if you can produce a paper trail they assume that the standard is met and vice versa which is not always a true representation. So surveys tend to revolve around many wasted hours ensuring that a “trail” can be followed through - yes, even altering staff meeting minutes, producing fake memos, etc etc.

Obsessive organisational skills and the ability to prioritise.

Personally, I love aged care and I’ve found that you either love or hate it, there’s not much inbetween. Be aware that gerontic nursing is a speciality - a lot of nurses go into it thinking it’s “easier” than acute nursing. It’s not easier or harder, but it requires a very different mindset and a knowledge of the ageing process and clinical assessment skills of the older person are essentials. Your rehabilitation, palliative and psychiatric qualifications/experience will be called upon also.

If it’s management you’re looking at, you’ll need some HR and budgeting experience and if the system in the US is similar to here, it will be an absolute that you have an in-depth knowledge of the funding and accreditation systems.

Good-bad-ugly? Well, I’m not keen on managing staff issues. I’ve had to deal with drug and alcohol abuse, domestic violence etc etc - but some people do enjoy staff management. My last DON was stalked by a crezzy employee, that’s not for me.

I also detest dealing with “difficult” families which are over-represented in aged care. I smile and nod and mentally tell them to “fuck off” - but hey, that’s just me also :slight_smile:

The good - well, recently I saw a resident who came to us two years ago bed-bound and incontinent and with a PEG feed following a bout of c difficile and pseudomembranous colitis. She’s now almost independent and was telling me how happy she was to finally be able to take herself to the toilet again. That’s a happy story but most times you have to take the happies where you find them and if it’s because you drew a number “11” on a piece of paper and handed it to the bi-polar who has been squawking all morning that she “neeeeeeeedssss eleven!” and the bi-polar is thrilled to bits with your piece of paper and says, “Yes! That’s eleven!!!” - well, that’s your happy for the day.

Hope it helps somewhat. Good Luck. You’ll need it.

I haven’t worked in this setting, but I have a co-worker who has. She accepted a position as the DON in a rehab hospital. She was on call 24/7, responsible for adminstrative stuff AND had to help fill in on the floors. She returned to her previous job as a staff nurse within six months, telling me no salary was worth the stress she endured in that position.

For what that’s worth.